Federalism and Health Care Reform: Understanding the States’ Challenges to the Patient Protection and Affordable Care Act

Abstract

Currently, a total of twenty-eight states are challenging the constitutionality of the Patient Protection and Affordable Care Act (PPACA) in federal court. Their principal claims are that the PPACA's regulation of the states violates their independent sovereignty, and that the Act's minimum coverage requirement exceeds Congress's enumerated powers. This litigation is immensely important, as it concerns a hugely significant statute and raises fundamental questions of constitutional federalism. This article offers a detailed description of the claims raised by the states and analyzes their plausibility under current law. It then addresses the likelihood that the Supreme Court will ultimately sustain the states' arguments and invalidate the PPACA.